Can fMRI-guidance Improve the Efficacy of rTMS Treatment for Auditory Verbal Hallucinations?

I.E.C. Sommer, C.W. Slotema, A.D. de Weijer, J. Blom, K. Daalman, S. Neggers, M. Somers, H. Hoek, A. Aleman, and R. Kahn, Schizophrenia Research, 2007, 93, 1, 406–8.

Abstract: The majority of auditory verbal hallucinations (AVH) are responsive to antipsychotic medication, but in 25-30% hallucinations persist despite adequate pharmacotherapy. Low frequency repetitive Transcranial Magnetic Stimulation (rTMS) offers an alternative treatment for this medication-resistant group. In this study we used individual functional Magnetic Resonance Imaging (fMRI) scans of hallucinatory activation to stereotactically guide TMS treatment to the cerebral area with maximal hallucinatory activation. From 15 participating patients, valid hallucinationrelated activation maps were obtained in 12 cases. Overall the severity of psychosis did not improve significantly while the time by type of treatment interaction showed a trend towards more improvement in the fMRI-guided group. The results of this study suggest that fMRI-guidance for rTMS treatment of AVH is feasible in the majority of patients with frequent AVH. This may indicate that fMRI-guidance can improve efficacy of rTMS treatment, though replication in a larger sample is needed. 

Excerpt: The majority of schizophrenia patients showed prominent activity in the right-sided homologues of the classical language areas during AVH [auditory verbal hallucinations] (i.e. in the right inferior frontal gyrus, right superior temporal gyrus and supramarginal gyrus), while normal language is generally produced in the left hemisphere in right-handed subjects.